Provider Demographics
NPI:1720118177
Name:RENAISSANCE WOMEN'S GROUP PA
Entity Type:Organization
Organization Name:RENAISSANCE WOMEN'S GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:G
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-425-3818
Mailing Address - Street 1:12201 RENFERT WAY STE 340
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5369
Mailing Address - Country:US
Mailing Address - Phone:512-425-3818
Mailing Address - Fax:512-425-3888
Practice Address - Street 1:12201 RENFERT WAY STE 340
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5369
Practice Address - Country:US
Practice Address - Phone:512-425-3818
Practice Address - Fax:512-425-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085526401Medicaid
TX00U04BMedicare ID - Type UnspecifiedMEDICARE GROUP #